American Journal of Obstetrics and Gynecology
January 2018 Volume 218, Issue 1, Supplement, Pages S516–S5http://www.ajog.org/issue/S0002-9378(17)X0012-4867: Cost-Effectiveness of the Tdap Vaccine During Pregnancy
BM Ameel, RH Beigi, AB Caughey –Abstract
Objective
Despite recommendations from the CDC’s Advisory Committee on Immunization Practice and ACOG, tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates during pregnancy remain very low at about 10%. Vaccinating pregnant women confers passive immunity to infants against pertussis, who experience significantly higher mortality from whooping cough. We sought to highlight the importance of this recommendation by assessing the cost-effectiveness of the Tdap vaccine in pregnant women for preventing pertussis infection in infants.
Study Design
We developed a decision-analytic model in TreeAge to assess the cost-effectiveness of vaccinating healthy pregnant women with the Tdap vaccine. Neonatal outcomes assessed included neonatal death and encephalopathy. All probabilities and costs were derived from the literature. Utilities were applied to discounted life expectancy at a discount rate of 3% to generate quality adjusted life years (QALYs). Sensitivity analyses were performed to assess the robustness of our model to changes in baseline.
Results
We found that vaccinating pregnant women according to current guidelines is the cost-effective strategy. For every 100,000 women vaccinated, 3 neonatal deaths, and 0.6 encephalopathy cases were avoided, and 99 QALYs were gained. With a baseline assumption of the cost of vaccine of $37.55, vaccination was cost effective at $19,659.20 per QALY. The results of the model remain cost-effective in sensitivity analyses that vary baseline prevalence of pertussis in infants to 1%, vaccine effectiveness down to 20%, and cost of the vaccine up to $100.00.
Conclusion
OB providers should ensure that pregnant women receive the Tdap vaccine during pregnancy, especially given recent data that show postpartum maternal vaccination and cocooning strategies are not effective. Public health strategies to encourage greater uptake of the Tdap vaccination should be employed.Health Economics
[01 Dec 2017, 26 Suppl 3:66-75]Behavioural consequences of vaccination recommendations: An experimental analysis.
R Böhm, NW Meier, L Korn, C BetschAbstract
Annual vaccination is the most effective way to prevent seasonal influenza. However, globally, the recommendations vary from country to country, ranging from universal recommendations, risk-group-specific recommendations, to no recommendation at all. Due to high diversity both in recommendation practice and country-specific preconditions, it is difficult to determine the effect of different recommendations on vaccine uptake. This incentivised laboratory experiment (N = 288) tests the behavioural consequences of different recommendations in a repeated interactive vaccination game. The participants are part of heterogeneous groups, comprised of low- and high-risk type of players. They receive either a universal, risk-group-specific or no recommendation prior to their vaccination decisions. Results show that individuals are sensitive to the recommendations. In detail, a risk-group-specific recommendation increases vaccine uptake of high-risk types. However, at the same time, it decreases vaccine uptake of low-risk types. The results imply that when the proportion of low-risk types in a population is considerably larger than the high-risk group, a risk-group-specific (vs. universal) recommendation comes at the cost of decreased social benefit of vaccination due to the overall lower vaccine uptake. Policy decision-making should therefore complement epidemiological considerations with potential positive and negative behavioural consequences of vaccination recommendations.Pediatrics International
Accepted manuscript online: 30 December 2017A questionnaire survey for parents in Nara prefecture, Japan about mumps vaccination
T Kitano, H Nishikawa, M Onaka, M Ishihara…
Although the mumps vaccine has not been included in the national immunization program (NIP) in Japan, it has been shown that a two-dose routine vaccine program would be highly cost-effective. In this study, we performed a questionnaire-based study to investigate how many Japanese parents want the mumps vaccine to be included in the NIP with proper information.